Provider Demographics
NPI:1316296197
Name:PETERSEN, BJARTA
Entity type:Individual
Prefix:MRS
First Name:BJARTA
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MASON STREET
Mailing Address - Street 2:UNIT 1
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-9998
Mailing Address - Country:US
Mailing Address - Phone:978-745-2440
Mailing Address - Fax:978-745-7615
Practice Address - Street 1:41 MASON STREET
Practice Address - Street 2:UNIT 1
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-9998
Practice Address - Country:US
Practice Address - Phone:978-745-2440
Practice Address - Fax:978-745-7615
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program